Question
A 33-year-old woman comes to the emergency department because of a 1-hour history of severe pelvic pain and nausea. She was diagnosed with a follicular cyst in the left ovary 3 months ago. The cyst was found incidentally during a fertility evaluation. A pelvic ultrasound with Doppler flow shows an enlarged, edematous left ovary with no blood flow. Laparoscopic evaluation shows necrosis of the left ovary, and a left oophorectomy is performed. During the procedure, blunt dissection of the left infundibulopelvic ligament is performed. Which of the following structures is most at risk of injury during this step of the surgery?
| A. |
Bladder trigone
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| B. |
Uterosacral ligament
|
| C. |
Ureter
|
| D. |
Uterine artery
|
Show Answer
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Correct Answer � C
Explanation
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|
Answer C) Ureter
This structure passes posterior to the infundibulopelvic ligament at the level of the pelvic brim.
Ureter
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The ureters pass through the pelvic brim within the ureteric fold, which lies posterior and medial, and in close proximity, to the infundibulopelvic ligament.
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Any dissection of the infundibulopelvic ligament should be performed with great care because of the risk of iatrogenic ureteral injury.
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Patients with fibrosis or endometriosis are at especially high risk of iatrogenic ureter injury during this surgical step.
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Because of their long retroperitoneal course, the ureters are at risk of injury during lower abdominal procedures, such as gonadal vessel ligation, uterine vessel ligation, pelvic dissection, and dissection at the ureterovesical junction.
Uterine artery
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The uterine artery (and vein) is contained within the cardinal ligament, which forms the inferior portion of the broad ligament.
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The uterine artery is located caudal to the infundibulopelvic ligament and is, therefore, unlikely to be injured during this step of the procedure.
Bladder trigone
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The bladder trigone is located at the base of the bladder, caudal to the infundibulopelvic ligament.
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This portion of the bladder is, therefore, unlikely to be injured during this step of the procedure.
Uterosacral ligament
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The uterosacral ligament connects the cervix to the sacrum and provides mechanical support to the uterus.
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This ligament is located caudal to the infundibulopelvic ligament and is, therefore, unlikely to be injured during this step of the procedure.
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